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中华眼科医学杂志(电子版) ›› 2021, Vol. 11 ›› Issue (06) : 359 -364. doi: 10.3877/cma.j.issn.2095-2007.2021.06.007

论著

青光眼患者常用大剂量滴眼液微生物污染情况的临床研究
王英明1, 殷雪1, 任亚璐2, 张晓峰3,()   
  1. 1. 215006 苏州大学附属第一医院眼科
    2. 215006 苏州大学附属第一医院临床检测中心
    3. 215006 苏州大学附属第一医院眼科;215123 苏州大学附属独墅湖医院眼科
  • 收稿日期:2021-03-10 出版日期:2021-12-28
  • 通信作者: 张晓峰
  • 基金资助:
    国家自然科学青年基金项目(8210060400); 江苏省自然科学基金项目(BK20210095)

The microbial contamination of commonly used multi-dose eye drops in glaucoma patients

Yingming Wang1, Xue Yin1, Yalu Ren2, Xiaofeng Zhang3,()   

  1. 1. Department of Ophthalmology, the First Affiliated Hospital of Soochow University, Suzhou 215006, China
    2. Center of Clinical Laboratory, the First Affiliated Hospital of Soochow University, Suzhou 215006, China
    3. Department of Ophthalmology, the First Affiliated Hospital of Soochow University, Suzhou 215006, China; Department of Ophthalmology, Dushu Lake Hospital Affiliated to Soochow University, Suzhou 215123, China
  • Received:2021-03-10 Published:2021-12-28
  • Corresponding author: Xiaofeng Zhang
引用本文:

王英明, 殷雪, 任亚璐, 张晓峰. 青光眼患者常用大剂量滴眼液微生物污染情况的临床研究[J]. 中华眼科医学杂志(电子版), 2021, 11(06): 359-364.

Yingming Wang, Xue Yin, Yalu Ren, Xiaofeng Zhang. The microbial contamination of commonly used multi-dose eye drops in glaucoma patients[J]. Chinese Journal of Ophthalmologic Medicine(Electronic Edition), 2021, 11(06): 359-364.

目的

探讨青光眼患者常用大剂量滴眼液的微生物污染情况和微生物种类。

方法

收集2019年5月至2020年4月于苏州大学附属第一医院眼科门诊就诊的青光眼患者所使用的250支滴眼液瓶。其中,抗青光眼滴眼液212支,抗生素滴眼液9支,抗生素类固醇滴眼液15支,非甾体抗炎滴眼液和散瞳滴眼液各7支。分别采集滴眼液滴头和瓶内残留滴眼液的微生物标本,并进行微生物培养,鉴定微生物的种类。滴眼液瓶的种类、污染的瓶数及阳性污染菌的株数采用频数表示。滴眼液瓶阳性污染菌的构成和滴眼液的污染率采用株数和百分比表示,组间比较采用卡方检验或Fisher精确检验。

结果

250支滴眼液中检出有微生物污染16支,占6.4%。滴头和瓶内残留滴眼液检出污染滴眼液分别为14支和2支,分别占5.6%和0.8%。经卡方检验,两者比较的差异有统计学意义(χ2=9.298,P<0.05)。抗青光眼滴眼液和非抗青光眼滴眼液分别检出污染滴眼液14支和2支,分别占6.6%和5.3%。经卡方检验,两者比较的差异无统计学意义(χ2=3.619,P>0.05)。抗生素滴眼液和非抗生素滴眼液检出污染滴眼液分别为0支和16支,分别占0和7.0%。经Fisher精确检验,两者比较的差异有统计学意义(P<0.05)。污染微生物中,共检测出细菌菌株16株,真菌菌株2株。以表皮葡萄球菌、大肠埃希菌及棒状杆菌属居多,分别为3株、3株及2株,分别占16.7%、16.7%及11.1%。

结论

滴头微生物污染检出率高于瓶内残留滴眼液,非抗生素类滴眼液微生物污染检出率高于抗生素。污染微生物以表皮葡萄球菌、大肠埃希菌及棒状杆菌属等环境常见菌株,青光眼患者的大剂量滴眼液易受到微生物污染,滴眼液的用药安全需引起重视。

Objective

The aim of this study was to investigate the microbial contamination and microbial species of ophthalmic multi-dose eye drops in glaucoma patients.

Methods

250 eye drops used by glaucoma patients in the Ophthalmology Clinic of the First Affiliated Hospital of Soochow University from May 2019 to April 2020 were collected. Among them, there were 212 anti-glaucoma eye drops, 9 antibiotic eye drops, 15 antibiotic steroid eye drops, 7 non-steroidal anti-inflammatory eye drops and 7 mydriasis eye drops. The dropper tip and the residual eye drops in the bottle were collected and cultured respectively, and then microbial species were identified. The type of eyedrop bottle, the number of contaminated cases and the number of positive contaminated bacteria were expressed as frequency. The composition of eye drop bottles and positive contaminating bacteria and the contamination rate of eye drops were expressed as the number of cases and percentage. Chi-square test or Fisher′s exact test were used for comparison between groups.

Results

16 of 250 eye drops were contaminated, accounting for 6.4%. 14 and 2 contaminated eye drops were detected in the dripper tip group and the residual eye drops group, accounting for 5.6% and 0.8%, respectively. Chi-square test showed that there was statistically significant difference between two groups (χ2=9.298, P<0.05). 14 and 2 contaminated eye drops were detected in anti-glaucoma eye drops group and non-anti-glaucoma eye drops group, accounting for 6.6% and 5.3%, respectively. Chi-square test showed that there was no significant difference between two groups (χ2 = 3.619, P>0.05). None and 16 contaminated eye drops were detected in antibiotic eye drops group and non antibiotic eye drops group, accounting for 0 and 7.0%, respectively. Fisher′s exact test showed that there were statistically significant difference between two groups (P<0.05). The contaminated microorganisms were composed of 16 bacterial strains and 2 fungal strains. 3 strains of Staphylococcus epidermidis accounting for 16.7%, 3 strains of Escherichia coli accounting for 16.7%, and 2 strains of Corynebacterium accounting for 11.1%, were the top three of frequency contaminated microbial. The detection of contamination in the dropper tip group was higher than that in the bottle residual eye drops group, and that in the non-antibiotic eye drops group was higher than that in the antibiotic group.

Conclusions

The contaminated microorganisms were mainly Staphylococcus epidermidis, Escherichia coli and Corynebacterium. Multi-dose eye drops are susceptible to microbial contamination, should be paid attention to the drug safety of eye drops for glaucoma patients.

表1 滴眼液瓶组成
表2 滴头组和残留滴眼液组微生物污染检出的结果
表3 滴头组和残留滴眼液组微生物污染检出率的比较[支(%)]
表4 抗青光眼滴眼液组与非抗青光眼滴眼液组微生物污染检出率的比较[支(%)]
表5 抗生素滴眼液组与非抗生素滴组微生物污染检出率的比较[支(%)]
表6 污染微生物的菌群分布和百分比
[1]
He S, Stankowska DL, Ellis DZ,et al.Targets of neuroprotection in glaucoma[J].J Ocul Pharmacol Ther,2018,34(1-2):85-106.
[2]
Bluwol E.Glaucoma treatment[J].Rev Prat,2016,66(5):508-513.
[3]
Weinreb RN, Aung T, Medeiros FA.The pathophysiology and treatment of glaucoma: a review[J].JAMA,2014,311(18):1901-1911.
[4]
Geyer O, Bottone EJ, Podos SM,et al.Microbial contamination of medications used to treat glaucoma[J].Br J Ophthalmol,1995,79(4):376-379.
[5]
Jokl DH, Wormser GP, Nichols NS,et al.Bacterial contamination of ophthalmic solutions used in an extended care facility[J].Br J Ophthalmol,2007,91(10):1308-1310.
[6]
Kyei S, Appiah E, Ayerakwa EA.Microbial safety implications of in-use topical diagnostic ophthalmic medications in eye clinics in Ghana[J].J Optom,2019,12(4):263-271.
[7]
Porges Y, Rothkoff L, Glick J,et al.Sterility of glaucoma medications among chronic users in the community[J].J Ocul Pharmacol Ther,2004,20(2):123-128.
[8]
Tamrat L, Gelaw Y, Beyene G,et al.Microbial contamination and antimicrobial resistance in use of ophthalmic solutions at the Department of Ophthalmology, Jimma University Specialized Hospital, Southwest Ethiopia[J].Can J Infect Dis Med Microbiol,2019:5372530.
[9]
Stevens JD, Matheson MM.Survey of the contamination of eyedrops of hospital inpatients and recommendations for the changing of current practice in eyedrop dispensing[J].Br J Ophthalmol,1992,76(1):36-38.
[10]
Tsegaw A, Tsegaw A, Abula T,et al.Bacterial contamination of multi-dose eye drops at Ophthalmology Department, University of Gondar, Northwest Ethiopia[J].Middle East Afr J Ophthalmol,2017,24(2):81-86.
[11]
Mah-Sadorra JH, Najjar DM, Rapuano CJ,et al.Serratia corneal ulcers: a retrospective clinical study[J].Cornea,2005,24(7):793-800.
[12]
Penland RL, Wilhelmus KR.Stenotrophomonas maltophilia ocular infections[J].Arch Ophthalmol,1996,114(4):433-436.
[13]
Teuchner B, Wagner J, Bechrakis NE,et al.Microbial contamination of glaucoma eyedrops used by patients compared with ocular medications used in the hospital[J].Medicine (Baltimore),2015,94(8):e583.
[14]
Fazeli MR, Nejad HB, Mehrgan H,et al.Microbial contamination of preserved ophthalmic drops in outpatient departments: possibility of an extended period of use[J].DARU J Pharmaceut Sci,2004,12:151-155.
[15]
Clark PJ, Ong B, Stanley CB.Contamination of diagnostic ophthalmic solutions in primary eye care settings[J].Mil Med,1997,162(7):501-506.
[16]
Nentwich MM, Kollmann KH, Meshack J,et al.Microbial contamination of multi-use ophthalmic solutions in Kenya[J].Br J Ophthalmol,2007,91(10):1265-1268.
[17]
Brudieu E, Duc DL, Masella JJ,et al.Bacterial contamination of multi-dose ocular solutions. A prospective study at the Grenoble Teaching Hospital[J].Pathol Biol (Paris),1999,47(10):1065-1070.
[18]
Schein OD, Wasson PJ, Boruchoff SA,et al.Microbial keratitis associated with contaminated ocular medications[J].Am J Ophthalmol,1988,105(4):361-365.
[19]
Feghhi M, Mahmoudabadi AZ, Mehdinejad M.Evaluation of fungal and bacterial contaminations of patient used ocular drops[J].Med Mycol,2008,46(1):17-21.
[20]
Kyei S, France D, Asiedu K.Microbial contamination of multiple-use bottles of fluorescein ophthalmic solution[J].Clin Exp Optom,2019,102(1):30-34.
[21]
Rahman MQ, Tejwani D, Wilson JA,et al.Microbial contamination of preservative free eye drops in multiple application containers[J].Br J Ophthalmol,2006,90(2):139-141.
[22]
Perry HD, Donnenfeld ED.Issues in the use of preservative free topicals[J].Manag Care,2003,12:39-41.
[23]
Kaur IP, Lal S, Rana C,et al.Ocular preservatives: associated risks and newer options[J].Cutan Ocul Toxicol,2009,28(3):93-103.
[24]
Furrer P, Mayer JM, Gurny R.Ocular tolerance of preservatives and alternatives[J].Eur J Pharm Biopharm,2002,53(3):263-280.
[25]
Epstein SP, Ahdoot M, Marcus E,et al.Comparative toxicity of preservatives on immortalized corneal and conjunctival epithelial cells[J].J Ocul Pharmacol Ther,2009,25(2):113-119.
[26]
Pisella PJ, Fillacier K, Elena PP,et al.Comparison of the effectsof preserved and unpreserved formulations of timolol on theocular surface of albino rabbits[J].Ophthalmic Res,2000,32(1):3-8.
[27]
Tripathi BJ, Tripathi RC.Cytotoxic effects of benzalkoniumchloride and chlorobutanol on human corneal epithelial cellsin vitro[J].Lens Eye Toxic Res,1989,6(3):395-403.
[28]
Stone JL, Robin AL, Novack GD,et al.An objective evaluation of eyedrop instillation in patients with glaucoma[J].Arch Ophthalmol,2009,127(6):732-736.
[29]
Taᶊli H, Coᶊar G.Microbial contamination of eye drops[J].Cent Eur J Public Health,2001,9(3):162-164.
[30]
Raynaud C, Laveran H, Rigal D,et al.Bacterial contamination of eyedrops in clinical use[J].J Fr phtalmol,1997,20(1):17-24.
[31]
Saisyo A, Shimono R, Oie S,et al.The risk of microbial contamination in multiple-dose preservative-free ophthalmic preparations[J].Biol Pharm Bull,2017,40(2):182-186.
[32]
Choy BNK, Zhu MM, Pang JCS,et al.Factors associated with poor eye drop administration technique and the role of patient education among Hong Kong elderly population[J].J Ophthalmol,2019,26:5962065.
[33]
Hosoda M, Yamabayashi S, Furuta M,et al.Do glaucoma patients use eye drops correctly?[J].J Glaucoma,1995,4(3):202-206.
[34]
Aptel F, Masset H, Burillon C,et al.The influence of disease severity on quality of eye-drop administration in patients with glaucoma or ocular hypertension[J].Br J Ophthalmol,2009,93(5):700-701.
[35]
Gao X, Yang Q, Huang W,et al.Evaluating eye drop instillation technique and its determinants in glaucoma patients[J].J Ophthalmol,2018:1376020.
[36]
Schneider KJ, Hollenhorst CN, Valicevic AN,et al.Impact of the support, educate, empower personalized glaucoma coaching program pilot study on eye drop instillation technique and self-efficacy[J].Ophthalmol Glaucoma,2021,4(1):42-50.
[37]
Su CY, Yang YC, Peng CF,et al.Risk of microbial contamination of unit-dose eyedrops within twenty four hours after first opening[J].J Formos Med Assoc,2005,104(12):968-971.
[38]
Oldham GB, Andrews V.Control of microbial contamination in unpreserved eyedrops[J].Br J Ophthalmol,1996,80(7):588-591.
[39]
Costa AXD, Yu MCZ, Freitas DD,et al.Microbial cross-contamination in multidose eyedrops: the impact of instillation angle and bottle geometry[J].Transl Vis Sci Technol,2020,9(7):7.
[40]
Davies IJ, Brown NH, Wen JC,et al.An upright eyedrop bottle: accuracy, usage of excess drops, and contamination compared to a conventional bottle[J].Clin Ophthalmol,2016,10:1411-1417.
[41]
Davies I, Williams AM, Muir KW.Aids for eye drop administration[J].Surv Ophthalmol,2017,62(3):332-345.
[42]
Salyani A, Birt C.Evaluation of an eye drop guide to aid self-administration by patients experienced with topical use of glaucoma medication[J].Can J Ophthalmol,2005,40(2):170-174.
[43]
Strungaru MH, Peck J, Compeau EC,et al.Mirror-hat device as a drop delivery aid: a pilot study[J].Can J Ophthalmol,2014,49(4):333-338.
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